Article ; Online: Application of the model-informed drug development paradigm to datopotamab deruxtecan dose selection for late-stage development.
CPT: pharmacometrics & systems pharmacology
2023 Volume 13, Issue 1, Page(s) 23–28
Abstract: To replace the conventional maximum tolerated dose (MTD) approach, a paradigm for dose optimization and dose selection that relies on model-informed drug development (MIDD) approaches has been proposed in oncology. Here, we report our application of an ... ...
Abstract | To replace the conventional maximum tolerated dose (MTD) approach, a paradigm for dose optimization and dose selection that relies on model-informed drug development (MIDD) approaches has been proposed in oncology. Here, we report our application of an MIDD approach during phase I to inform dose selection for the late-stage development of datopotamab deruxtecan (Dato-DXd). Dato-DXd is a TROP2-directed antibody-drug conjugate being developed for advanced/metastatic non-small cell lung cancer (NSCLC) and other tumors. Data on pharmacokinetics (PKs), efficacy, and safety in NSCLC were collected in the TROPION-PanTumor01 phase I dose-expansion and -escalation study over a wide dose range of 0.27-10 mg/kg administered every 3 weeks. Population PK and exposure-response analyses were performed iteratively at three data cutoffs to inform dose selection. The 6 mg/kg dose was identified as the optimal dose by the second data cutoff analysis and confirmed by the subsequent third data cutoff analysis. The 6 mg/kg dose was more tolerable (i.e., lower rates of interstitial lung disease, stomatitis, and mucosal inflammation) than the MTD (8 mg/kg) and was more efficacious than 4 mg/kg (simulated mean objective response rate: 23.8% vs. 18.6%; mean hazard ratio of progression-free survival: 0.74) - a candidate dose studied just below 6 mg/kg. Therefore, the 6 mg/kg dose was judged to afford the optimal benefit-risk balance. This case study demonstrated the utility of an MIDD approach for dose optimization and dose selection. |
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MeSH term(s) | Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Lung Neoplasms/drug therapy ; Antineoplastic Agents/therapeutic use ; Drug Development ; Immunoconjugates/pharmacokinetics |
Chemical Substances | Antineoplastic Agents ; Immunoconjugates |
Language | English |
Publishing date | 2023-11-01 |
Publishing country | United States |
Document type | Clinical Trial, Phase I ; Case Reports |
ZDB-ID | 2697010-7 |
ISSN | 2163-8306 ; 2163-8306 |
ISSN (online) | 2163-8306 |
ISSN | 2163-8306 |
DOI | 10.1002/psp4.13058 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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